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Understanding Small Fibre Neuropathy
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Introduction

Small Fiber Neuropathy (SFN) is a type of peripheral neuropathy characterized by damage to the small unmyelinated C fibers and thinly myelinated Aδ fibers. These small fibers are responsible for transmitting pain and temperature sensations, as well as autonomic functions such as heart rate, blood pressure, and sweating. Unlike large fiber neuropathies, SFN primarily affects the skin, leading to symptoms that can be quite debilitating despite the absence of muscle weakness or loss of large fiber-mediated sensations.

Symptoms of Small Fiber Neuropathy

The symptoms of SFN can vary widely but typically include:

  • Pain: Often described as burning, stabbing, or electric shock-like in nature.
  • Paraesthesia: Abnormal sensations such as tingling or prickling.
  • Allodynia: Pain from stimuli that do not normally provoke pain.
  • Autonomic Symptoms: Including abnormal sweating, digestive issues, and cardiovascular problems.

Diagnosis of Small Fiber Neuropathy

Diagnosing SFN involves a combination of clinical evaluation, patient history, and specific tests. Key diagnostic tools include:

  • Skin Biopsy: A small sample of skin is taken to quantify the density of nerve fibers. Reduced nerve fiber density is a hallmark of SFN.
  • Quantitative Sensory Testing (QST): Measures the threshold for detecting sensations such as temperature and vibration.
  • Autonomic Function Testing: Assesses the function of the autonomic nervous system.

Causes of Small Fiber Neuropathy

SFN can be caused by a variety of factors, including genetic mutations, metabolic disorders, infections, and autoimmune diseases. One significant category of causes includes toxic exposures.

 

Toxic Causes of Small Fiber Neuropathy

Industrial Agents

  1. Acrylamide: Used in industries such as dye, paper, plastic, and adhesive manufacturing, as well as in water processing. Acrylamide is toxic to nerve terminals and can lead to a length-dependent pansensory-motor polyneuropathy with prominent sensory ataxia. Chronic exposure results in skin irritation, hyperhidrosis, and significant peripheral neuropathy​.

  2. n-Hexane and ‘Glue-Sniffing’: n-Hexane is a solvent used in glue and textile manufacturing. Recreational inhalation, known as 'glue-sniffing,' can cause a distal sensorimotor neuropathy characterized by progressive sensory symptoms and weakness. Onset can be acute or insidious, depending on the exposure level. High doses can result in significant conduction slowing, conduction block, and temporal dispersion in nerve conduction studies​.

  3. Organophosphates: These are commonly used as pesticides and insecticides. Organophosphate poisoning can lead to a neuropathy presenting as distal numbness, paraesthesiae, cramping, and weakness with bilateral foot drop. The onset typically occurs around three weeks post-exposure, and the neuropathy is often mild, predominantly affecting motor function without significant sensory disturbance​.

Heavy Metals

  1. Arsenic and Thallium: Exposure to arsenic and thallium can lead to sensory-predominant neuropathies with symptoms such as hyperkeratosis and Mees' lines on the fingernails. These metals cause a rapid progression of neuropathy, often presenting as acute or subacute sensorimotor neuropathy resembling Guillain-Barré Syndrome (GBS)​.

  2. Lead: Lead poisoning results in a predominantly motor neuropathy with significant distal weakness. It is often associated with other systemic symptoms such as abdominal pain and cognitive disturbances​.

  3. Mercury: Exposure to mercury, particularly in industrial settings or through contaminated food sources like fish, can lead to sensory neuropathy. Symptoms include distal paresthesia and pain.

Please note there are numerous heavy metals linked to neuropathy.

 

Chemotherapy Drugs

Certain chemotherapy agents are known to cause peripheral neuropathy, including SFN. These include:

  1. Platinum Compounds: Drugs like cisplatin and oxaliplatin can cause a sensory neuronopathy with symptoms such as sensory ataxia and paraesthesiae. Oxaliplatin, in particular, can lead to an acute neural hyperexcitability syndrome​.

  2. Taxanes: Paclitaxel and docetaxel commonly induce painful sensory neuropathies. Patients may also experience acute arthralgia and myalgia​.

  3. Vinca Alkaloids: Vincristine is associated with distal weakness and sensory symptoms, often accompanied by autonomic involvement​.

Recreational Drugs and Alcohol

  1. Nitrous Oxide: Chronic use of nitrous oxide, often recreationally, can cause a sensory-predominant neuropathy with significant distal motor weakness and autonomic dysfunction​​.

  2. Alcohol: Chronic alcohol consumption can lead to a slowly progressive neuropathy with predominant sensory involvement. This neuropathy is often multifactorial, with both direct toxic effects and nutritional deficiencies contributing to the condition​.

Look out for my posts on how to repair nerves after they are exposed to toxins.

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The Controversy Surrounding PCR Testing: An In-Depth Look

The Polymerase Chain Reaction (PCR) test, created by Dr. Kary Mullis in 1985, has become a vital tool in genetic research and diagnostics. This method allows for the amplification of small DNA segments, making detailed study possible. However, its application, especially in diagnosing viral infections like COVID-19, has stirred significant debate. Critics claim that the science behind its widespread use lacks sufficient backing. This post aims to explore these criticisms and examine the scientific arguments against using PCR tests as a diagnostic tool for COVID-19.

 

Understanding PCR Testing

Dr. Kary Mullis designed the PCR test to replicate genetic material, enabling detailed scientific study. The process involves cycles of amplification, where each cycle doubles the DNA amount. While this technology has revolutionized molecular biology, its use in diagnosing viral infections presents several concerns.

 

Potential for Misinterpretation

A key criticism of PCR testing, particularly for COVID-19, is the risk of misinterpretation due to over-amplification. Dr. Mullis himself noted that the PCR test is intended for research, not for diagnosing illnesses. He highlighted that with enough amplification, one can find almost anything in any sample, which doesn’t necessarily indicate disease.

Experts echo this concern, emphasizing the cycle threshold (CT)—the number of cycles needed to detect the virus—as a critical factor in test reliability. High CT values can detect non-infectious viral fragments, leading to false positives. The World Health Organization (WHO) recommends a CT value below 35, but many labs have used higher thresholds, adding to the controversy.

 

Development of the COVID-19 PCR Test

The rapid development of the PCR test for COVID-19 by virologist Christian Drosten has also faced scrutiny. Critics argue that Drosten's test, created shortly after the Chinese government published viral genomic sequences, was not adequately validated against real viral samples. They claim the test relied on theoretical constructs and assumptions, raising questions about its accuracy and reliability.

 

Amplification and False Positives

False positives are a significant concern. When the sequences used in PCR tests are compared with the human genome database, overlaps with human and bacterial/fungal genetic material are found. This non-specific detection can lead to many positive results that may not reflect actual infections. Furthermore, the cycle thresholds used in various laboratories vary widely, with some exceeding 40-45 cycles, which critics argue is scientifically unsound and leads to unreliable results.

 

Issues with Primer Sequences and Business Interests

Drosten's PCR test has faced criticism for using degenerate primer sequences, which are not 100% specific and can react with various sequences, increasing false positives. Additionally, allegations of conflicts of interest have arisen, as Drosten developed the test for Roche, a company with substantial interest in the test's success. Critics suggest this relationship may have influenced the test’s rapid and widespread adoption without adequate validation.

 

Lack of Proper Validation

A significant criticism is that the PCR test used for COVID-19 diagnosis did not undergo rigorous validation, essential for clinical diagnostics. Typically, a new test should be validated against a "gold standard" to ensure accuracy. Drosten's PCR test, however, was released under Emergency Use Authorization (EUA) without thorough validation, leading to doubts about its scientific credibility.

 

Misinterpretation of Positive Results

The variability in PCR test results, where asymptomatic individuals test positive while symptomatic individuals test negative, further complicates matters. This discrepancy may stem from the test's sensitivity in detecting minute viral RNA fragments that do not indicate an active infection. As a result, the test might identify non-infectious viral debris, especially in asymptomatic individuals or those recovered from infection, leading to a high rate of false positives.

 

Expert Opinions and Sources

Numerous experts and studies have raised concerns about the PCR tests for diagnosing COVID-19:

  1. Statements from CDC and WHO: Both organizations have noted that detecting viral RNA through PCR does not necessarily indicate the presence of an infectious virus and should not be solely relied upon for COVID-19 diagnosis.
  2. Legal and Medical Opinions: Over 1,000 lawyers and 10,000 doctors have filed lawsuits citing the Nuremberg Code, arguing that PCR tests are unsuitable for pathogen detection and are inaccurate at higher cycle thresholds. 
  3. Scientific Review: A review by 21 scientists, including former Pfizer VP Michael Yeadon, criticizes the COVID-19 PCR test for being based on theoretical sequences without proper validation against live or inactivated virus samples.

Conclusion

The use of PCR testing for diagnosing COVID-19 is highly contentious. While the technology is crucial in genetic research, its application as a diagnostic tool for viral infections has significant flaws.

Misinterpretation risks, issues with over-amplification, and questions about the test's development and validation highlight the need for re-evaluating its use. This post will continue to delve into these issues, considering the implications for public health and future diagnostic practices.

 

References

  • World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) statements on PCR testing.
  • Review by 21 scientists on the validation of PCR tests
  • Legal and scientific analyses from experts, including former Pfizer VP Michael Yeadon.
  • Mullis, Kary
  • Cowan, Tom
  • Diaz, Jacob
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